Out-of-pocket costs comprise approximately one-sixth of health care expenditures and nearly one-half of expenditures on prescription medicines. These costs pose a burden on many patients and are associated with non-adherence and other barriers to quality care. Dr. Alexander's previous work suggests that patient physician communication about out-of-pocket prescription costs is an important yet neglected aspect of current clinical practice. Such findings may be especially relevant to elderly patients who are more likely to be on multiple medications and have fixed incomes. In this proposed randomized trial, Dr. Alexander will develop, implement, and evaluate the effectiveness of an intervention designed to assist patients and physicians in safely reducing patients' out-of-pocket prescription costs. One hundred and eighty patients treated by 45 general internists and geriatricians will be recruited for the study from 8 physician practices. The intervention includes both patient- and physician-targeted strategies designed to overcome previously identified barriers to reducing patients' out-of-pocket costs. Primary outcomes of the study will be compared between baseline and six to eight weeks following patients' index office visit and include the impact of the [unreadable] intervention on out-of-pocket costs, medication appropriateness, health status, and burden from out-of pocket costs. Secondary outcomes will examine the effect of the interventions on rates of patient-physician discussions about costs, how changes in out-of-pocket costs are achieved (e.g. switching from brand name to generic equivalent), and barriers that may prevent enhanced intervention effectiveness (e.g. patient discomfort initiating discussions about prescription costs). The recently passed Medicare Modernization Act makes this research especially relevant because it leaves substantial gaps in coverage for beneficiaries of average means who incur high drug expenses. As a former Robert Wood Johnson Clinical Scholar with an established track record examining patient-physician communication about out-of-pocket costs, Dr. Alexander is in an ideal candidate to explore this important interface between bioethics, health policy, and clinical medicine. [unreadable] [unreadable] [unreadable] [unreadable]